In patients with acute coronary syndrome (ACS), the incidence of atrial fibrillation (AF) ranges from 10 to 21% and is an independent predictor of poor long-term outcomes including death [1, 2]. The choice of antithrombotic therapy for AF patients with concomitant ACS or patients who have undergone percutaneous coronary intervention (PCI) with coronary stenting is challenging [1]. Dual antiplatelet therapy is indicated to reduce cardiovascular ischemic events including stent thrombosis, and is not proven to protect against AF-related strokes [3]. In contrast, oral anticoagulation is proven to prevent ischemic stroke and systemic embolism in patients with AF but has not been shown to reduce stent thrombosis [3]. However, triple therapy with dual antiplatelets and an anticoagulant increases the risk of bleeding [4]. Therefore, alternative strategies to balance the risk of bleeding and ischemic events in this high-risk population is needed. Although previous trials have shown a...